Hypertension - the Medically Compromised Patient

1. By: Kelli Adreon Aimee Martin Michaela Neie Hypertension -the Medically Compromised Patient

2. What is Hypertension? • An abnormal elevation of arterial blood pressure • Two-thirds of people over the age of 65 have HBP • Also known as the “silent killer” due to 1/3 of population with disease do not show or are unaware of their symptoms • Risk factor for cardiovascular disease, kidney disease, myocardial infarction, cerebrovascular accident, and premature death

3. DiastolicVs. Systolic • Diastolic-Pressure exerted by blood within the arteries during the total resting resistance after the contraction of the left ventricle • Systolic-Pressure exerted against the arterial walls during the ventricular contraction

5. Etiology • Primary Hypertension: • Incidence: • Approximately 95% of all hypertension is primary • Predisposing/Risk Factors: • Tobacco use • Heredity • Overweight • Race • Sodium intake • Sex • Age • Environment

6. Etiology • Secondary Hypertension • Incidence: • About 5% of all hypertension is secondary to another underlying health condition • Usually both systolic and diastolic blood pressures are elevated • Contributing Factors: • Oral contraceptives • Renal disease • Endocrine disorders • Medications

7. Occurrence/Population • African Americans more so than other ethnicities • More prevalent in men <45 • Women slightly more than men in older years • Illness more severe and mortality rate higher at younger age

8. Symptoms • Occipital Headaches • Dizziness • Visual Disturbances • Weakness • Tinnitus • Tingling extremities

9. HypertensiveConditions • Hypertensive crisis • Major Sequela • Malignant Hypertension • ACTIVATE EMS IMMEDIATELY!!

10. Hypertension in Children • Familial tendency • Complete medical history on child as well as parent • >3 years old need BP determinations made annually • Children 3-12 years with diastolic >90 further investigation is indicated

11. Role of the RDH • Recognize the physical, medical, mental, and dental needs of the patient. • Monitor vital signs • Communicate and build rapport • Appropriate treatment plan

12. Treatment Plan • Thorough medical history • Assess vitals at every appointment and during treatment • Determine hypertensive condition • Refer if needed • Stress free environment • Avoid sudden change in position • Consider semi-supine • Short appointments • Recall • Saliva substitute & home fluoride • Nitrous Oxide may be recommended

13. Lifestyle Modifications • Weight control • Limit alcohol intake • Smoking cessation • Exercise daily • Reduce sodium intake • Maintain dietary K, Ca, Mg intake • Reduce saturated fat and cholesterol intake

14. Prescribed Medications • Anti-hypertensive medications: • Diuretics • ACE inhibitors • Alpha blockers • Beta blockers • Calcium channel blockers

15. OralManifestations • No oral manifestations • Side effects due to antihypertensive drugs: • Xerostomia • Gingival enlargement • Salivary gland swelling or pain • Erythema multiforme • Lichen planus • Taste alteration • Parathesia

16. Contraindications • Local anesthetic with vasoconstrictor • Severe hypertension • Air polisher

17. In conclusion: • Dental hygienists have regular contact with dental patients due to frequent recall appointments. Therefore, hygienists are in a unique position to assess blood pressure and increase a patient’s awareness about the risk associated with hypertension. • Dental hygienists have a great opportunity to educate their patients on the health risks associated with hypertension, recommend appropriate lifestyle modifications, and promote healthy lifestyles.

18. 1. The course of action to take for a patient with a BP reading of 166/100 would be? • Delay all dental treatment until BP readings are consistent • Re-check in 5 min and consult the patients physician • Observe patient during dental treatment and reevaluate at recall appointment • Immediate referral to hospital ER

19. Answer • B. Re-check in 5 min and consult the patients physician

20. Your patient is hypertensive which of the following should not be used? • Ultrasonic scaler • Rubber cup polisher • Air polisher • Oral irrigator

21. Answer • C. Air Polisher

22. Nitrous oxide helps patients to relieve anxiety in the dental office. Nitrous oxide is contraindicated with hypertensive patients. • Both statements are true. • Both statements are false. • The first statement is true, and the second statement is false. • The first statement is false, and the second statement is true.

23. Answer • C. The first statement is true, and the second statement is false.

24. References: • Chowdhary, R., & Kumar, P., & Mastan, K., & Shanmugam, K. (2012). Oral manifestations in hypertensive patients: A clinical study. Journal of Oral and Maxillofacial Pathology, 16(2), 215-221. doi: 10.4103/0973-029X.99069 • Fehrenbach, Margaret J. (2013). Blood pressure issues in the dental office. Retrieved from http://www.richmondinstitute.com/wp-content/uploads/2013/05/Blood-Pressure-Issues-in-the- Dental-Office-CE- Course-PDF.pdf • High blood pressure-oral health implications. (2011). Retrieved from http://www.claredental.com/?p=461 • The importance of measuring blood pressure in dental offices. (2008). Retrieved from http://adctoday.com/sites/default/files/literature/9000Whitepaper0002.pdf • Wilkins, E. M. (2013). Clinical Practice of the Dental Hygienist (11th edition). Lippincott Williams & Wilkins, 1012-1014.